НАЦИОНАЛЬНАЯ ПРОГРАММА по профилактике и контролю сердечно-сосудистых заболеваний на 2014-2020 годы

Objectives

The National Programme for the Prevention and Control of Cardiovascular Diseases for 2014-2020 is Moldova’s strategic framework for reducing cardiovascular morbidity, disability and mortality, increasing life expectancy, and contributing to the World Health Organization objective of reducing premature mortality from non-communicable diseases by 25% by 2025.[1][2][3]It sets a national target to reduce cardiovascular mortality by 10% by 2020, equivalent to an average annual reduction of 1.5%, and to reduce acute cardiovascular and cerebrovascular events by 20%.[4][5]The programme responds to a substantial disease burden, with cardiovascular diseases accounting for about 57.5% of deaths during the preceding decade and high levels of registered hypertension, cerebrovascular disease, myocardial infarction and congenital or rheumatic heart disease.[6][7][8]

• Reduce behavioural and metabolic risk factors, including tobacco use, unhealthy diet, physical inactivity, hypertension, diabetes, obesity and dyslipidaemia, through population prevention, health knowledge and individual cardiovascular-risk assessment.[2][9][10]
• Improve prevention and early diagnosis among children, young people, healthy adults, high-risk groups and people with established cardiovascular disease, including earlier identification of congenital heart defects and increased registration of adults with hypertension.[9][11][12]
• Modernise diagnosis, specialised treatment and rehabilitation, including interventional cardiology, coronary revascularisation, cardiac rhythm management, cardiovascular surgery, emergency reperfusion and palliative care for severe heart failure.[4][13][14][15]
• Strengthen secondary prevention, medication adherence, compensated medicines for chronic cardiovascular disease, rehabilitation and support for self-care in order to prevent complications, repeat hospitalisation, disability and premature death.[9][15][16]
• Develop workforce capacity, updated protocols, research priorities and registries for major cardiovascular diseases, supported by information systems covering adults and children receiving cardiology and cardiac-surgical care.[17]

Implementation

Implementation combines prevention, screening, risk assessment, primary care, specialised outpatient and hospital services, emergency care, rehabilitation, professional education, research and electronic monitoring.[4][18]The programme is delivered through an Action Plan, with phased implementation from 2014 to 2020, baseline analysis and preliminary review by the end of 2016, followed by continued implementation and monitoring during 2017-2020.[19][18]Overall implementation control, assessment of annual reports and reporting to Government are assigned to the Ministry of Health, while public medical and sanitary institution managers are responsible for the reliability of submitted indicator data.[20][21]

• Develop and finance territorial prevention and control programmes through municipal councils, Gagauzia’s autonomous territorial authorities and district councils, aligned with the national programme.[19][18]
• Apply the HeartScore individual cardiovascular-risk model for populations registered with family doctors in high-risk settings, aiming for 80% to 100% coverage, and expand annual examinations and peripheral atherosclerosis detection towards full coverage by 2020.[11]
• Increase public knowledge of risk factors and prevention by 20% by 2020, and improve primary-care practice so that at least 80% of cardiovascular diseases in adults and children are detected early.[9]
• Equip coronary intensive-care units in new regional hospitals, establish anticoagulant and tertiary-care capacity, introduce electrocardiographic technologies, and expand e-health and telemonitoring centres for risk monitoring, rehabilitation, secondary prevention and staff training.[11][13]
• Establish or strengthen regional and local interventional cardiology centres, cardiac-surgery capacity for adults and children, rehabilitation services at inpatient, outpatient and home-based levels, and integrated local care for severe cardiovascular disease.[14][15][22][16]
• Update national and institutional diagnostic and treatment protocols, introduce biochemical markers and anticoagulant monitoring, promote minimally invasive and urgent coronary angioplasty methods, and develop public-private partnerships for specialised cardiology services.[13][23]
• Strengthen undergraduate, specialist and continuing education for cardiology-related professions, train family doctors and other professionals through e-health and telemonitoring modules, and align curricula with international directions.[15][17]
• Monitor progress through annual indicator reporting to the Ministry of Health by 15 March, Ministry assessment and submission to Government by 15 April, and a final effectiveness report by the end of 2020.[20][21]
• Track mortality, morbidity, disability, risk-factor prevalence, screening coverage, risk scores, treatment and protocol implementation, equipment availability, registry connectivity and the introduction of new diagnostic or therapeutic methods.[5][10][23][22]
• Finance the programme from national public-budget resources and other legally permitted sources; use mandatory health insurance funds to reimburse medicines for chronic cardiovascular disease.[19][5][16]

Monitoring & Evaluation

The programme combines population-health targets, service indicators, electronic monitoring, annual reporting and a final effectiveness review. It assigns the Ministry of Health a central assessment role, while public medical and sanitary institution managers are responsible for the reliability of submitted indicator data.[20][21]

• Track high-level outcomes, including a 10% reduction in cardiovascular mortality by 2020, equivalent to an intended annual reduction of 1.5%, and a 20% reduction in acute cardiovascular and cerebrovascular events by 2020.[4][5]
• Measure prevention and early-detection performance through a 20% increase in public knowledge of cardiovascular risk factors and prevention measures, and early detection of at least 80% of cardiovascular diseases among adults and children.[9]
• Monitor individual cardiovascular risk using the HeartScore model, with intended coverage of 80% to 100% of people registered with family doctors in high-risk settings, and assess peripheral atherosclerosis detection with a target of 100% coverage by 2020.[11]
• Assess clinical and service outcomes through targets for a 30% increase in life expectancy among patients with prevalent cardiovascular diseases, 50% patient participation in combined treatment and secondary and tertiary prevention, and palliative care for 10% of patients with severe heart failure.[11][15]
• Use national registers to record modern diagnostic and treatment methods and morbidity, disability and mortality parameters, supporting assessment of the planned measures' effectiveness.[5]
• Monitor population health through an electronic control system, including risk-factor trends among the general population and high-risk groups and the quality of primary and secondary prevention during 2017-2020.[18]
• Collect detailed prevention indicators, including screening coverage, prevalence of cardiovascular risk factors, HeartScore risk categories, hypertension and dyslipidaemia prevalence, statin use, and risk assessment among adults and children.[10][23]
• Track diagnostic and treatment capacity through equipment availability, biochemical markers, anticoagulant monitoring, compliance with national and institutional protocols, registry-connected centres, remote monitoring and the development of new methods.[23]
• Require ministries and other participating central public authorities to submit annual accounts of implementation measures to the Ministry of Health by 15 March; require the Ministry to assess these reports and submit its assessment to the Government by 15 April.[20]
• Submit programme-indicator results annually to the Ministry of Health by 15 March under the action plan, and produce a final report by the end of 2020 assessing implementation and effectiveness.[21]
• Review the baseline position for primary prevention, screening and early diagnosis during 2014-2016, review preliminary implementation results at the end of 2016, and continue monitoring during 2017-2020.[18]

The extracts do not provide complete indicator definitions, a consistent surveillance methodology, data ownership arrangements, independent evaluation procedures, sanctions for non-compliance, or a comprehensive reporting schedule beyond the specified annual and final reporting requirements.[20][18][12][21]

Costing & Financing

Financing is envisaged through national public budget resources, other sources permitted by applicable legislation, and reimbursement of medicines for chronic cardiovascular disease through mandatory health insurance funds. No monetary programme budget, allocation by activity, expenditure total, funding gap or economic assumption is supplied in the extracts.[19][5][16]

• Finance national and territorial cardiovascular-disease prevention and control programmes, with local authorities recommended to develop, approve, fund and implement territorial programmes aligned with the national framework.[19]
• Fund planned implementation activities, including prevention, diagnostic and treatment modernisation, intensive-care equipment, e-health centres, rehabilitation, specialised cardiology, surgery, professional training, research and registry development.[11][13][17][18]
• Reimburse medicines for people with chronic cardiovascular disease through mandatory health insurance funds, although no allocation or reimbursement level is specified.[16]
• Reference preliminary implementation costs in an annex, without providing the associated amounts, cost categories or assumptions in the supplied material.[5]

The extracts do not specify annual appropriations, the division of financing between national and local levels, donor or private-sector contributions, resource-mobilisation targets, affordability analysis, unit costs, or funding shortfalls.[19][5][22][21]